CT定位上腔静脉在评价PICC置管中的应用价值  

Localization of Superior Vena Cava on CT for PICC Position

作　　者：梁明柱[1] 陈晓君[1] 秦培鑫[1] 敖峰[1] 毛利厅 陈欢[1] 柳学国[1] 

机构地区：[1]中山大学附属第五医院放射科,珠海519000

出　　处：《临床放射学杂志》2017年第7期984-988,共5页Journal of Clinical Radiology

摘　　要：目的观察上腔静脉与气管隆突的影像关系并评价其在外周静脉置入中心静脉导管(PICC)中的应用价值。方法测量100例胸部CT增强患者(增强观察组)气管隆突至上腔静脉下端的距离及其对应的胸椎单元数目,并计算上腔静脉下1/3段的上端在气管隆突下所处的位置。以上腔静脉下1/3段作为PICC尖端的理想位置,在CT定位扫描图判断100例PICC患者(导管组)是否置管成功。结果增强观察组上腔静脉下端(即下上腔静脉1/3段的下端)位于气管隆突下(48.5±6.7)mm,对应2.1±0.3个胸椎单元,而上腔静脉下1/3段的上端位于气管隆突下(21.5±5.9)mm,对应0.9±0.3个胸椎单元。以气管隆突下0.9~2.1个胸椎单元作为上腔静脉下1/3段的参考标准,在导管组CT定位图上判断PICC尖端是否位于理想位置的准确性高于以气管隆突下21.5~48.5mm作为参考标准(92%vs 71%,P<0.05)。结论气管隆突下0.9~2.1个胸椎单元可以作为判断PICC尖端是否位于上腔静脉下1/3段的参考。Objective To study the relationship of the superior vena cava（ SVC） and the carina on CT and determine the tip position of peripherally inserted central catheter（ PICC）. Methods 100 consecutive patients who received contrast enhanced CT scan were retrospectively studied by measuring the distance between the carina and the cavoatrial junction（ CAJ）in terms of absolute value and corresponding vertebral body unit（ VBU）. The distance between the carina and the upper end of the lower one-third of the SVC was also measured. Using the reference of lower one-third of the SVC as the optimal position,the tips of PICC in another 100 patients were observed on both CT scout images and thin slice axial images. Results The distance between the CAJ and the carina was measured 48. 5mm ± 6. 7,which was corresponding to 2. 1 ± 0. 3 VBU. The upper end of lower one third of the SVC was measured 21. 5mm ± 5. 9 below the carina,which was corresponding to 0. 9 ± 0. 3VBU. The accuracy of determining the PICC to be in the optimal position by using the range of 0. 9-2. 1 VBU below the carina as the reference of lower one third of the SVC was better than that of using the range of 21. 5-48. 5 mm below the carina as the reference（ 92% vs. 71%,P〈0. 05）. Conclusion The range of 0. 9-2. 1 VBU below the carina is well corresponding to the lower one third of the SVC which can be used as the reference for the PICC position.

关 键 词：体层摄影术 X线计算机 外周静脉置入中心静脉导管 上腔静脉 

分 类 号：R446.8[医药卫生—诊断学] R816.2[医药卫生—临床医学]